Every year, the Robert Wood Johnson Foundation awards its Culture of Health Prize to up to 10 communities across the country. Prizewinners exemplify the importance of locally driven change in the quest to ensure everyone, no matter who they are or where they live, has the opportunity for good health. We say it often: When it comes to building a Culture of Health, the challenges are many and the solutions seldom straightforward. But we’ve got to start somewhere, and for several Prize-winning communities, that somewhere was the annual County Health Rankings.

This month, the Foundation and the University of Wisconsin released the seventh installment of the Rankings, which measure the health of nearly all counties in the nation and ranks them within each state. Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play.

Over the years, communities have taken notice of these rankings, especially when their community scores low compared to other counties in their state. Two 2015 Prize-winning communities in particular—The Bronx, New York (62 out of 62), and Menominee Nation, Wisconsin (72 out of 72)—used their rankings as a wake up call and first step on their journey to a better and brighter future.

The Rankings can represent a starting point for any community. Real effects can be felt across a region when people come together to make a difference. Here are some ways the Rankings can become a catalyst for change:

As a rallying cry. For health and community activists in The Bronx, the hashtag #Not62 became not just a way to announce health initiatives, but also a rallying cry. It’s a way of saying, “We’re more than our rank.”

“Social and economic realities can’t change overnight,” said State Senator Gustavo Rivera, who represents sections of the borough. “But I’m convinced that the work people have been doing for a long time will change the number for the better.”

As a source of data and a way to zero in on what to focus on. The Rankings are compiled using county-level measures from a variety of national and state data sources. These measures are standardized and combined using scientifically informed weights. In The Bronx, community leaders could easily see that just over 40 percent of children in their county lived in poverty and the unemployment rate (7.7 percent) was higher than New York City’s (5.6 percent). These measured health factors became key indicators for the community to focus on to begin making measurable changes.

As a way to involve the community. Spurred by its last-place ranking, Menominee Nation turned to the Adverse Childhood Experiences (ACE) scale, which measures “quality of life.” On a scale of one to ten—the higher the score, the higher the risk of health problems—members rated their past experiences with physical, emotional or sexual abuse or neglect, family substance use or abuse, domestic violence in the family or mental illness in the family.

Most scored at a four or above, the common denominator being trauma.

With a common understanding of how deep its health problems went, Menominee Nation was able to call back to its tribal roots and bring people together to gradually heal their community from the inside out.

As a way to focus resources. “There are a lot of reasons for that last-place ranking,” said Roger William Barr, psychotherapist at a tribal clinic. “When you’re dealing with trauma, change takes a lot of strength and support. Historically, our community has had trouble doing that.”

Using the Rankings and their ACE scores, Menominee Nation began instituting trauma-informed care beginning with their youngest and most vulnerable population, children. If Menominee children could learn to name the emotions that incited their trauma, the reasoning went, they’d be better equipped to identify and mitigate those feelings in the future to begin breaking the cycle of poverty and poor health.

For many communities just beginning their journey to a Culture of Health, being able to see where they stand on multiple health factors is both jarring and necessary. The Bronx and Menominee Nation used the County Health Rankings as a valuable tool to drive their dramatic changes. It is the hope of the Robert Wood Johnson Foundation that these County Health Rankings can be a spark of motivation when it comes to change for better health outcomes across the nation.

Michelle A. Larkin, JD, MS, RN, is interim vice president and associate chief of staff. She directs all program and administrative activities of the Robert Wood Johnson Foundation’s program portfolios. In this role, she helps shape the Foundation’s strategies, policies, and impact, building a Culture of Health for our nation where everyone has the opportunity to live healthier lives, no matter where they live or how much they make. Read her full bio.

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